MEDICARE: OHARA HOME CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1912652447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHARA HOME CARE LLC

Provider Business Mailing Address
First Line	:	651 E MAIN ST STE 6
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4241
Country	:	US
Telephone Number	:	863-521-5629
Fax Number	:

Provider Business Practice Location Address
First Line	:	651 E MAIN ST STE 6
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4241
Country	:	US
Telephone Number	:	863-521-5629
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JOY GENUNG
Credential	:
Telephone Number	:	253-226-1177

Provider Enumeration Date	:	02/14/2022
Last Update Date	:	03/17/2022

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